first aid africa syllabus.pdf

FIRST AID AFRICA

Syllabus

2nd

Edition

First Aid Africa 2011


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Editors Scott Clarke - Policy and Development Coordinator Laura Janes Dan Costigliola - Training Coordinator With thanks to Lyn Covey - First Aid Technical Support Officer, British Red Cross Harry McLaren - Alumni and Communications Coordinator Matt May Copyright 2011 This document is the exclusive property of First Aid Africa. It may not be quoted, distributed or copied, in whole or in part, without the explicit permission of the copyright holder; First Aid Africa. Disclaimer Every effort has been made to ensure that the information contained in this document is correct at the time of going to press. However, this document is designed for use overseas not the United Kingdom. First Aid Africa take no responsibility for the use of any of the information or techniques in this document. If you have any enquiries about this syllabus, please contact [email protected].


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1. Introduction 4 2. How to use this syllabus 4 3. Teaching Tips 5 4. First Aid Africa Courses 6 5. First Aid Aware 5.1 Introduction to First Aid 7

5.2 The Unconscious Casualty 8

5.3 Blood Loss and Shock 9

5.4 Burns 13

5.5 Fractures 16

6. Initial First Aid 18 7. Advanced First Aid 7.1 Introduction to First Aid 19

7.2 First Aid Equipment 21

7.3 The Unconscious Casualty 22

7.4 Blood Loss and Shock 24

7.5 Burns 31

7.6 Fractures 35

7.7 Head Injury 42

7.8 Medical Conditions 44

7.9 Choking 58

7.10 Sports Injuries 61

7.11 Moving, Handling & Transporting Casualties 63

8. Changes Log 67

CONTENTS


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The aim of this guide is to help you to adapt what you have learnt in your UK first aid course to teaching in overseas. It is not designed to replace your first aid manual but should be used alongside your manual when planning lessons. If you have any questions or problems whilst using this guide, please contact [email protected].

The next few pages provide information about the different levels of course that you can deliver. The rest of the trainers guide contains the syllabuses for each of the courses:

At the start of each section is a reference for the appropriate pages in the first aid manual and, where necessary, the important changes between the older and most up to date versions of the manual. You should make sure you read these sections before you plan your lesson so that you understand enough of the theory behind the subject to be able to teach it.

The learning objectives are given for each section. They are not designed to be given to your class but rather to guide your teaching.

Any adaptations or additions in technique for overseas are included. It is very important that you read this section to make sure your course is relevant.

Key, often lifesaving, points to be emphasised with your class are highlighted.

Any resources we have available to help you teach the topic are referenced at the end of each section.

SYLLABUS INTRODUCTION

HOW TO USE THIS SYLLABUS


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Planning

Read over the relevant sections of your manual and this guide before you try to plan

your lesson

It can take time to relax into teaching your classes - preparing well makes this a lot

easier

When planning your lessons it is important to think about:

Who are you trying to teach? age, language abilities, disabilities, number in the class, previous knowledge etc

What are you trying to teach? what do you want your class be able to do by the end of your session?

What do you need to help you? equipment, visual aids, number of trainers etc

How are you going to teach it? demonstration, class practice, scenarios etc

First aid is a practical subject - give your class as much chance to practise the

practical skills as possible and dont focus as much on theory

Teaching

Be enthusiastic

Try and vary how you teach - dont just stand at the front lecturing the whole time

First aid is a practical subject - the more time your students spend practising the

techniques the better

Have fun...but remember youre the teacher, when teaching children especially, you need to earn their respect and maintain it

Dont talk over the class, make sure theyre quiet before you start

Dont contradict each other in front of the class

When telling a child off, dont threaten to do something youre not going to do...they learn quick!

Assessments

Assessment information is given in a separate document. Its a good idea to read up on how the course will be assessed before you plan your lessons, particularly in First Aid Aware. Assessments are competence based and you can continually assess your students rather than having to do specific assessments at the end of the course.

Remember, if you think things arent going as well as they could, talk to your team leaders early on. Were here to help you and your students get the best out of the

project!

TEACHING TIPS


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FIRST AID AFRICA COURSES First Aid Africa courses are based on courses that are currently offered by voluntary aid organisations in the UK but are adapted for overseas. The courses do not cover CPR as it is unlikely that the rest of the steps of the Chain-of-Survival will be in place. The information below gives the suggested target audience for each course you can deliver as well as the teaching time needed for delivery. It is intended as a guide to help you decide which course is appropriate for your class rather than as a set rule of what you must teach and how long it should take.

FIRST AID AWARE

Pages: 7 - 17

Time: 3 hours / day

Audience: Primary school students, people who just want to learn basic skills

First Aid Aware is designed to cover basic first aid and emphasises the need to get help from someone who knows more. It covers the life-saving, initial aspects of treatment for:

an unconscious casualty,

blood loss and shock;

and the initial treatments for: burns and,

fractures.

It is similar to a UK Save-a-Life Course. It is not designed to cover a large amount of theory. In order to pass this course, students do not need to be able to understand the principles behind treatment but they must be able to treat effectively.

INTIAL FIRST AID

Pages: 18

Time: Approx 2 days / 14 hours - 3 days including assessments

Audience: Teachers, secondary school students and community members who want to learn skills without learning a large amount of theory

Initial First Aid is designed to teach the skills needed to initially treat a casualty and arrange for an Advanced First Aider to come and help. It covers a similar amount of content to a UK Basic First Aid Course. It is not designed to cover a large amount of theory. In order to pass this course, students do not need to be able to understand the principles behind treatment but they must be able to treat effectively.

ADVANCED FIRST AID

Pages: 19 - 66

Time: Approx 5 days / 28 hours - including assessments

Audience: Teachers, older students and community members who have a desire to learn First Aid - this course requires a reasonable level of English

Advanced First Aid is currently the most advanced course First Aid Africa run overseas. It covers a similar amount of content to a UK Standard First Aid Course. The course covers everything from the initial treatment of a casualty through to the transport of the casualty to the hospital as well as covering some of the theory behind the treatments. Both local first aid equipment and improvised techniques are used throughout. You should encourage teachers in your school to take this course.


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FIRST AID AWARE

5.1 INTRODUCTION TO FIRST AID

Learning Objectives Protection from infection By the end of this section, a learner should:

understand the risk of cross infection involved with first aid

understand the importance of using gloves to protect both the casualty and the

first aider

Assessing danger By the end of this section, a learner should:

understand that the most important person at the scene is the first aider

understand the importance of checking for danger

be able to give examples of danger and how to deal with them including:

road traffic accidents

fire

electricity

muggings

First Aid Manual

9th Edition - Chapters 1 & 2, p12 - 37

8th Edition - Chapter 1, p12 - 28

Overseas

Make sure you make it clear that GLOVES reduce the risk of infection

Dangers you use as examples should be appropriate to the area - snakes and

machetes rather than kettles and freezing lakes Do not be afraid to give HIV as an example of infection that can be transmitted -

many older African children will know more about HIV than you Road traffic accidents are very common in Africa

Key Points The first aider is the most important person - you can not help someone else if you

are injured - check for DANGER Wear GLOVES - you should recap this at the start of every treatment you do!

Resources Page 4 - Danger


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FIRST AID AWARE

5.2 THE UNCONSCIOUS CASUALTY

Learning Objectives DRS ABC By the end of this section, a learner should:

be able to carry out the steps in DRS AB:

Check for Danger using the knowledge from the previous section Check for Response shake and shout Shout for Help

Open the Airway using the head-tilt, chin-lift method Check for normal Breathing using the look, listen and feel method Circulation - check for life threatening blood loss and treat

Recovery Position By the end of this section, a learner should:

understand the importance of the recovery position especially:

having the casualty on their side - in case theyre sick maintaining an open airway - without an airway they will die

having a casualty in a stable position - to keep them safe

be able to carry out the steps of the recovery position

Getting Help By the end of this section, a learner should:

understand the importance of getting help to transport an unconscious

casualty

First Aid Manual

9th Edition - Chapters 4, p54 - 79; Chapter 3, p44 - 53, Chapter 13, p256 - 257

8th Edition - Chapter 3, p71 - 98; Chapter 13, p252 - 262

Key Points Check for danger before helping any casualty

If you do not open an unconscious persons airway and keep it open, they will die because they wont be able to breath

Always re-open a casualtys airway after you have moved them, even if you have only moved them slightly

The recovery position is the safest position for an unconscious casualty to be in

Get help as quickly as possible

Resources Page 7 - DRS ABC

Page 8 - Recovery Position


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FIRST AID AWARE

5.3 BLOOD LOSS AND SHOCK

Learning Objectives

Personal Protection By the end of this section, a learner should:

understand the importance of wearing gloves to treat a wound

Types of Wounds By the end of this section, a learner should:

be able to distinguish between severe bleeding and minor wounds

understand that major wounds lead to major blood loss which needs to be

stemmed quickly

Severe Bleeding - Pressure By the end of this section, a learner should:

understand that you should be apply PRESSURE to a wound to stop the

bleeding understand different methods of applying pressure, mainly,

by using the patient or first aiders gloved hands by using a bandage

by using an improvised bandage

Severe Bleeding Bandaging To Apply Pressure By the end of this section, a learner should:

be able to use a sterile ambulance dressing / local equivalent to bandage a

severe wound to the arms including the hands

the legs

the head

be able to select and use an appropriate improvised bandage which should be

as clean as possible

able to produce sufficient pressure

large enough to cover the wound

understand the importance of, and be able to check for, circulation beyond the

bandage/improvised bandage understand what to do when blood soaks through a bandage

Severe Bleeding Embedded Object By the end of this section, a learner should:

understand that you should not remove an embedded object

understand why you should apply pressure either side of the object, not

directly on top

First Aid Manual

9th Edition - Chapter 1, p16 - 19; Chapter 6, p106 - 109, 113 - 129;

Chapter 13, p266 - 267; Chapter 5, p103

8th Edition - Chapter 5, p118 - 122, Chapter 6, p127 - 144; Chapter 13, p270;

Chapter 4, p112 - 113


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be able to apply pressure either side of the embedded object using their hands

be able to bandage around an embedded object

Shock By the end of this section, a learner should:

understand that shock can happen as a result of blood loss

be able to recognise and understand the main signs and symptoms of shock,

mainly a rapid pulse

pale, cold, clammy skin

weakness and dizziness / tiredness and decreasing level of

consciousness eventually leading to unconsciousness thirst

nausea

feeling cold

Shock - Treatment By the end of this section, a learner should:

be able to treat a casualty for shock by

lying the patient down

keeping them warm

monitoring their level of consciousness and being ready to treat them

for unconsciousness Severe Bleeding and Shock - Getting Help By the end of this section, a learner should:

understand the importance of getting help to treat a casualty with a severe

bleed and/or shock know where to get help

Minor Wounds - Treatment By the end of this section, a learner should understand that:

minor wounds should be seen by a more qualified first aider

Snake Bites By the end of this section, a learner should:

be able to recognise a snake bite

understand that a bite from a venomous snake is very dangerous

be able to treat a snake bite by:

not approaching if the snake is still near the casualty

keeping the casualty as calm and still as possible

FIRST AID AWARE


Overseas

Emphasise using gloves

Teach using both local and UK bandages


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FIRST AID AWARE


It is custom in Africa to wash the wound...if it is a minor graze or small cut, perfect!

However, if it is a large cut or wound there is no need for it to be placed under the water as the blood would carry out any residues from inside the wound. The priority is to stop the bleed - PRESSURE

Elevation is not taught in FAA overseas courses - an international review found that

there is no evidence that pressure in conjunction with elevation is more effective than pressure alone and this is easier to teach

Raising the patients legs as part of the treatment for shock is not taught in FAA overseas courses no studies have shown that there is any survival benefit over lying the casualty down alone and at least one study has shown that it worsens outcome. In addition, it is easier to teach that the treatment for shock is to lie the patient down and keep them warm

Improvised bandages should be as clean as possible, non-fluffy, able to produce

sufficient pressure and cover the entire wound. An example would be a clean t-shirt. The bandage should be replaced with a sterile dressing as soon as possible.

Get help from a more advanced first aider as soon as possible

Venomous snakes are more common in Africa. A bite from a venomous snake

generally looks like the diagram below but any snake bite should be treated as if the snake is venomous

Do not approach a casualty with a snake bite when the snake is still near the casualty

Do not try and catch the snake

Calm a casualty with a snake bite down as quickly as possible, make them lie down

with their head and shoulders raised - get help Do not cut open the wound or try and suck out the venom - this puts the first aider in

Large fangs which inject venom Other teeth


Wear GLOVES

The priority when treating severe wounds is to stop the bleeding

Treatment for a severe bleed is PRESSURE

Bleeding, both internal and external can lead to shock

Shock is very dangerous and can cause death

Someone who is shocked will be pale, cold, clammy, feeling weak/tired/dizzy/

nauseous, will have a decreasing level of consciousness and will have a rapid but weak pulse

Treatment for shock is laying the casualty down, keeping them warm and stopping

the bleeding with pressure - transport to HOSPITAL If someone has been bitten by a snake, make sure the area is safe before treating -

do not approach a casualty when the snake is still near them The key parts of treating for a snake bite are: get the casualty to lay still with their

head and shoulders raised, get help - dont let them walk Do not cut open the wound or try and suck out the venom - this puts the first aider in


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FIRST AID AWARE


Resources Page 11 - Severe Bleeding

Page 14 - Snake Bites


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Learning Objectives Burns By the end of this section, a learner should:

understand that a burn is damage to the skin

understand that blisters are part of the body's defence against burns and that

you should not burst them understand that chemicals may still be burning, even if you cant see them understand that burns to the airway are very dangerous as they can stop you

being able to breath Cooling By the end of this section, a learner should:

understand that unless a burn is cooled and/or the chemical is fully washed

off, damage will continue to be done to the skin understand that a normal burn has to be cooled until it no longer feels like it is

burning and for a minimum of 10 minutes understand why clean, cold, running water is the best thing to cool a burn

be able to cool a burn using

running, cold, clean liquids (not strong alcohol)

a basin of cold, clean liquid and a cup

running, unclean, cold liquid and something to cover the burn

a basin of cold, unclean liquid, a cup and something to cover the burn

Additional Treatment By the end of this section, a learner should:

understand that anything tight around a limb near a burn such as clothing or

rings should be removed because of the risk of swelling understand why you should not remove anything that is stuck to the burn

Getting Help By the end of this section, a learner should:

FIRST AID AWARE

5.4 BURNS

First Aid Manual


8th Edition - Chapter 9, p189 - 200; Chapter 13, p277

Overseas

The English word burn is not very commonly used in Africa. If you try explaining to someone in English what a burn is it can be quite hard so its a good idea to have pictures of burns, or examples of things that can give you a burn, to help you


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FIRST AID AWARE

5.4 BURNS

The information below is not intended to be given to every class during the First Aid Aware course. It is intended to help you answer questions Burns are generally very badly treated by lay people in Africa because of the wide

variety of local remedies used, such as putting rabbit hair on the burn to help it heal. Invariably, these increase the chance of infection and make the situation worse

In many cases, local remedies are part of the traditions of local culture - do not

rubbish the ideas but explain why they might not work as well as the treatment you are teaching them, in terms of lack of cooling and increased chance of infection - many local people will have stories of burns that have got worse after local treatment and these can help convince people

Burns ALWAYS need to be cooled first - if the burn is not cooled, it will continue to

cause damage deeper and deeper in to the skin even if you cannot see it doing so. Some local remedies are actually quite good BUT only if applied AFTER cooling - for example honey is a natural antiseptic and seals the skin preventing infection from entering. However, if you put honey on a burn which isnt cool, its like adding a glaze to a cooking steak!

The best thing to cool a burn is clean, cold, running water

clean to reduce the chance of infection

cold because you want to cool the burn

running because running water takes heat with it as it goes and stays

cool where as standing water heats up if you put a burn into it You are almost guaranteed to be asked these questions:

What if I dont have water? What if I dont have clean water? What if I dont have much water? What if I dont have running water? combinations of the above!

The priority initially is always to cool the burn If you do not have water, any cool clean liquid will do (except drinks with a high alcohol content such as Konyagi as it really hurts - beer is ok) If you only have unclean liquid, cover the burn very loosely with something clean and non-adherent/fluffy - preferably plastic - and pour water over the top. The cooling process will take longer If you don't have very much liquid or liquid is not running, place a big bowl underneath the area you are cooling to collect the liquid and then use a cup or a

Key Points Check for danger before helping any casualty - especially things that may have

caused the burn Wear GLOVES

Initial treatment of a burn is cooling to stop more damage

A burn should ALWAYS be cooled first - cold, clean, running water is the best thing to

cool a burn - if you dont have it, do the best you can! Most burns should be cooled until they no longer feel hot to the casualty - at least 10

minutes for most Get help from a more advanced first aider, doctor or nurse

Bad burns can lead to shock


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FIRST AID AWARE

5.4 BURNS

Resources Page 16 - Burns (examples)

Page 17 - Burns (treatment)


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Learning Objectives Fractures By the end of this section, a learner should:

understand what a fracture is

understand that a fracture can be open or closed

be able to recognise a fracture

understand that if you are not completely sure that something is NOT

fractured, you should get help but treat it as a fracture until help arrives

Support and Protect By the end of this section, a learner should:

understand that the casualty will automatically adopt a position to support and

protect the fracture understand that the aim of treating a fracture is to support and protect the

fracture site Open Fracture By the end of this section, a learner should:

understand the that you need to control the bleeding before treating the

fracture be able to control the bleeding of an open fracture by treating the protruding

bone as an embedded object understand that after you have controlled the bleeding, you should treat the

fracture as normal Upper Limb By the end of this section, a learner should:

be able to provide the initial treatment for a suspected fracture to an upper

limb by: asking the casualty to support and protect the area themselves

getting help from a more advanced first aider

Lower Limb By the end of this section, a learner should:

be able to provide the initial treatment for a suspected fracture to a lower limb

by: providing initial support above and below the fracture site using the

first aiders hands

FIRST AID AWARE

5.5 FRACTURES

First Aid Manual

9th Edition - Chapter 7, p130 - 158; Chapter 13, p268, p272

8th Edition - Chapter 7, p145 - 174, Chapter 13, p273, p276

The changes between the manuals are not relevant for this course.


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caused the fracture Wear GLOVES

Types of fracture:

Closed skin is not broken

bone ends may still have damaged nearby blood vessels and so risk

of internal bleeding Open

bone poking through skin

likely to be bleeding

treating the bleed takes priority - treat as an embedded object

Both can be serious and lead to shock Always fully expose a fracture site to make sure there is no bleeding

The principle behind treating all suspected fractures is to support and protect

Upper Body Fractures Allow the casualty to support the suspected fracture for themselves

Get help from a more advanced first aider

Upper and Lower Leg Fractures Support above and below the suspected fracture site with your hands

Get help from a more advanced first aider - dont let go send someone else - if you are on your own, get help first

FIRST AID AWARE

5.5 FRACTURES

Resources Page 23 - Leg Fracture


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The Initial First Aid course is based on the Advanced First Aid Course. The differences are explained below. For all of the sections, concentrate more on practical skills than theory. Transport is not included - get help from a more advanced first aider or do the best they can.

INITIAL FIRST AID

TITLE ADVANCED FIRST AID

UNIT NOTES UNIT RESOURCES

INTRODUCTION TO FIRST AID

7.1 6.1 Page 4

FIRST AID EQUIPMENT

7.2

Just make them aware of both UK and local bandages - not how to make Teach triangular bandage folding

6.2 Page 6

THE UNCONSCIOUS CASUALTY

7.3 Do not teach baby recovery position

6.3 Pages 7 & 8

BLOOD LOSS AND SHOCK

7.4 Do not teach abdomen or open chest wounds

6.4 Pages 11 & 14

BURNS 7.5

When teaching which burns go to hospital, emphasise that basically the bad, big and burns to delicate areas go to hospital, dont focus too much on all the different criteria - if in doubt send to hospital

6.5 Pages 16 & 18

FRACTURES 7.6

Only teach holding above and below a fracture to the lower limb, not bandaging - get help from a more advanced first aider

6.6 Pages 21, 22, 23

HEAD INJURY 7.7 6.7 ---

MEDICAL CONDITIONS

7.8

Teach the initial treatment of seizures, diabetes, and asthma and how to recognise heart attack & stroke. For all other conditions - get help from a more advanced first aider

6.8 ---

CHOKING 7.9 6.9 Pages 33 & 34

SPORTS INJURIES

7.10 Only mention bandaging briefly - no practise just demo

6.10 ---

MOVING, HANDLING & TRANSPORTING CASUALTIES

7.11 Do not teach - get help from a more advanced first aider / do their best

---


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ADVANCED FIRST AID


Learning Objectives Role of the first aider By the end of this section, a learner should understand the aims of first aid including:

Preserve life

Prevent condition from worsening

Promote recovery

Protection from infection By the end of this section, a learner should:

understand the risk of cross infection involved with first aid

understand the importance of using gloves to protect both the casualty and the

first aider understand the importance of safe disposal of contaminated equipment

Assessing danger By the end of this section, a learner should:

understand that the most important person at the scene is the first aider

understand the importance of checking for danger

be able to give examples of danger and how to deal with them including:

road traffic accidents

fire

electricity

muggings

First Aid Priorities By the end of this section, a learner should:

understand that priority is given to the injury most likely to kill the person first

understand that in most cases, airway takes priority

First Aid Equipment By the end of this section, a learner should:

understand what equipment should be included in their first aid kit

First Aid Manual

9th Edition - Chapters 1 & 2, p12 - 37


Overseas

Make sure you make it clear that GLOVES reduce the risk of infection

Get details of local hospitals/dispensaries as contaminated materials can be safely

disposed of in many African Hospitals - team leaders and teachers will be able to help you do this

Dangers you use as examples should be appropriate to the area - snakes and

machetes rather than kettles and freezing lakes


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ADVANCED FIRST AID


Do not be afraid to give HIV as an example of infection that can be transmitted -

many older African children will know more about HIV than you Road traffic accidents are very common in Africa

Making local bandages will be covered in your induction and information is also

Key Points The first aider is the most important person - you can not help someone else if you

are injured - check for DANGER Wear GLOVES - you should recap this at the start of every treatment you do!

The most important thing is to save the persons life - treat the injury that is most likely to kill them first - in most cases airway is the most important

Resources Page 4 - Danger


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ADVANCED FIRST AID

7.2 FIRST AID EQUIPMENT

Learning Objectives Equipment Availability By the end of this section, a learner should understand that:

Important first aid equipment can be expensive and difficult to get hold of

Alternatives can be made using readily available, cheaper, local materials

If there is no proper equipment available, you should improvise and do the

best that you can Local Equipment By the end of this section, a learner should be able to make equipment out of local materials:

Triangular bandages - material cut to size

Ambulance dressings - material strip and sanitary pad Triangular Bandages By the end of this section, a learner should be able to fold triangular bandages into:

Broad-fold

Narrow-fold

First Aid Manual

9th Edition - Chapter 12, p249, 253

8th Edition - Chapter 2, p57, 62

Overseas

First aid equipment imported from the Western World may be difficult to get hold of in

overseas and is usually expensive Effective alternatives can be made from readily available local materials which are

cheaper Triangular bandages can be made, simply by cutting a piece of material down to size

- try and use a similar material to that which the UK triangular bandages are made out of

Bandages which are similar to ambulance dressings can be made by sticking a

sanitary pad to a strip of cloth Whilst sanitary pads may appear to be an odd choice, they are in fact made for

purpose - they are designed for absorbing blood and are very clean. They are also readily available in African pharmacies relatively cheaply

Making equipment out of local materials will be covered in your induction as well as in

Resources Page 5 - Local Bandages

Page 6 - Triangular Bandages


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ADVANCED FIRST AID


Learning Objectives Unconsciousness By the end of this section, a learner should:

understand what the term unconscious means

be able to give example causes of unconsciousness

DRS ABC By the end of this section, a learner should:

understand the importance of DRS ABC

be able to carry out the steps in DRS ABC:

Check for Danger using the knowledge from the previous section Check for Response using Alert, Voice, Pain, Unresponsive Shout for Help

Open the Airway using the head-tilt, chin-lift method Check for normal Breathing using the look, listen and feel method Circulation - check for life threatening blood loss and treat

Recovery Position By the end of this section, a learner should:

understand the importance of the recovery position especially:

having the casualty on their side

maintaining an open airway

having a casualty in a stable position

be able to carry out the steps of the recovery position

Head-to-toe Survey By the end of this section, a learner should:

understand the importance of sending someone to organise transport before

starting a head-to-toe survey - the person needs to get to hospital quickly understand the reasons behind doing a head-to-toe survey

be able to carry out a head-to-toe survey

Babies By the end of this section, a learner should:

understand the differences in treatment for an unconscious baby

be able to put a baby in the modified recovery position

Safe Transport By the end of this section, a learner should:

understand the importance of transporting an unconscious casualty to hospital

quickly Transport of an unconscious casualty will be covered in section 7.10: Moving,

Handling & Transporting Casualties

First Aid Manual

9th Edition - Chapters 4, p54 - 79; Chapter 3, p44 - 53, Chapter 13, p256 - 257



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ADVANCED FIRST AID


Overseas

In the UK, we ring 999 and wait for an ambulance to arrive for an unconscious

casualty - in Africa the first aider must arrange for transport to the nearest hospital as quickly as possible - see section 7.10: Moving, Handling & Transporting Casualties

If their conscious level improves they still need to go to the hospital


If you do not open an unconscious persons airway and keep it open, they will die because they wont be able to breath

Always re-open a casualtys airway after you have moved them, even if you have only moved them slightly

The recovery position is the safest position for an unconscious casualty to be in

An unconscious casualty should be transported to hospital as quickly as possible

Resources Page 7 - DRS ABC

Page 9 - Recovery Position

Page 10 - Unconscious Baby


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ADVANCED FIRST AID


Learning Objectives The Importance of Blood By the end of this section, a learner should:

understand the importance of blood, including

its role in carrying oxygen and nutrients around the body

its role in removing waste materials from the body

its role in the transmission of disease

Personal Protection By the end of this section, a learner should:

understand the importance of wearing gloves to treat a wound

Types of Wounds By the end of this section, a learner should:

be able to distinguish between severe bleeding and minor wounds

understand the implications of the type of wound on the priorities of treatment,

mainly that:

First Aid Manual

9th Edition - Chapter 1, p16 - 19; Chapter 6, p106 - 109, 113 - 129;

Chapter 13, p266 - 267; Chapter 5, p103

8th Edition - Chapter 5, p118 - 122, Chapter 6, p127 - 144; Chapter 13, p270;

Chapter 4, p112 - 113

The treatment for a snake bite has changed in the 9th Edition:

1. Reassure and calm the casualty and lie them down with their head and shoulders raised - call 999/112 for emergency help

2. If there is no pain or the wound is deep, apply an ambulance dressing at the site of the bite. Do not remove clothing from around the site (can speed up venom absorption)

3. Apply another pressure bandage (crepe) from the bite, extending as far as possible up the limb (as per 8th Edition) - if possible mark the site of the bite

4. If the bite is on a limb, immobilise the affected limb, in a sling if it is an arm, or if it is a leg that is affected, secure it to the other leg with broad- and narrow- fold bandages

5. Monitor and record vital signs while waiting for help to arrive. The casualty needs to remain still

Take precautions to prevent others being bitten. DO NOT try to capture the snake - get help from someone who is qualified.

The 9th Edition emphasises the need to hold the bandage firmly against the wound when treating an abdominal wound. This reflects the difficulties in tying a bandage around the abdomen when the casualty is laying down and suggests simply holding a sterile dressing on with your gloved hands, in addition to securing the dressing


25

major wounds lead to major blood loss which needs to be stemmed

quickly minor wounds are likely to become infected

Severe Bleeding - Pressure By the end of this section, a learner should:

understand the importance of pressure when treating a severe bleed, mainly,

that it improves clotting

stems the flow of blood

understand different methods of applying pressure, mainly,

by using the patient or first aiders gloved hands by using a bandage

by using an improvised bandage

Severe Bleeding Bandaging To Apply Pressure By the end of this section, a learner should:

be able to use a sterile ambulance dressing / Tanzanian equivalent to

bandage a severe wound to the arms including the hands

the legs

the head

be able to select and use an appropriate improvised bandage which should be


able to produce sufficient pressure

large enough to cover the wound

understand the importance of, and be able to check for, circulation beyond the

bandage/improvised bandage understand what to do when blood soaks through a bandage

Severe Bleeding Embedded Object By the end of this section, a learner should:

understand why you should not remove an embedded object

understand why you should apply pressure either side of the object, not

directly on top be able to apply pressure either side of the embedded object using their hands

be able to bandage around an embedded object

Severe Bleeding - Tourniquet By the end of this section, a learner should:

understand that you should ONLY use a tourniquet for wounds to the limbs

which were NOT controlled by pressure alone understand the potential complications of using a tourniquet and subsequent

lack of blood flow past the point of application, mainly temporary or permanent nerve damage

temporary or permanent muscle damage

temporary or permanent damage to blood vessels

loss of the limb

understand that the longer it takes to get the patient to hospital, the more likely

they are to suffer from one of the complications above 2 hours - generally no permanent effects

ADVANCED FIRST AID



26

ADVANCED FIRST AID


>6 hours requires amputation

understand that you should tell the casualty that there is a chance they may

lose their limb if they do not get to a hospital quickly understand the importance of recording the time that the tourniquet was

applied and passing on the information to the hospital - ideally, by writing the time on the limb, above the tourniquet

be able to make and apply an improvised tourniquet

Shock By the end of this section, a learner should:

understand what shock is, mainly that

it is the body's defence against blood loss, either external or internal

the blood supply to the peripheral tissues, such as the skin, shuts

down to divert blood to the important internal organs such as the brain and the liver

blood pools in the muscles

be able to recognise and understand the main signs and symptoms of shock,

mainly a rapid pulse

pale, cold, clammy skin

weakness and dizziness / tiredness and decreasing level of

consciousness eventually leading to unconsciousness thirst

nausea

feeling cold

Shock - Treatment By the end of this section, a learner should:

be able to treat a casualty for shock by

lying the patient down

keeping them warm

monitoring their level of consciousness and being ready to treat them

for unconsciousness Severe Bleeding and Shock - Safe Transport By the end of this section, a learner should:

understand the importance of transporting a casualty with a severe bleed or in

shock to hospital quickly Transport of a casualty with a severe bleed or showing signs of shock will be covered

in section 7.10: Moving, Handling & Transporting Casualties Minor Wounds - Treatment By the end of this section, a learner should:

understand the importance of washing a minor wound with clean water, mainly

that it cleans the wound reducing the risk of infection understand the importance of washing around the wound

understand the need to cover a minor wound to prevent infection

be able to cover a minor wound using a sterile gauze or sterile non-adhesive

pad be able to cover a minor wound using an improvised dressing which should be


27

ADVANCED FIRST AID



large enough to completely cover the wound

Infection By the end of this section, a learner should understand that:

any wound can get infected

infection is caused by bacteria contaminating the wound

if an infected wound is not treated it can lead to serious illness

Infection - Recognition and Treatment By the end of this section, a learner should:

be able to recognise an infected wound

understand the importance of carefully cleaning an infected wound

understand that a badly affected wound needs to be treated by a doctor or

nurse Animal and Human Bites By the end of this section, a learner should:

understand the increased risk of infection from animal and human bites

be able to treat a deep wound caused by a bite like a normal deep wound

be able to treat a less severe bite by washing with soap and water and

covering with a sterile dressing understand the importance of transporting a casualty with a bite to hospital

Snake Bites By the end of this section, a learner should:

be able to recognise a snake bite

understand the risks of a bite from a venomous snake

understand that the treatment of a venomous snake bite relies on trying to

prevent the venom from spreading quickly be able to treat a snake bite by:

keeping the casualty as calm and still as possible

carefully lying the casualty down with their head and shoulders raised

applying compression bandages

immobilising an affected limb

arranging immediate transport to hospital with as little movement of

the casualty as possible Open Chest Wound By the end of this section, a learner should:

understand that an open wound to the chest can cause difficult breathing and

why be able to treat an open chest wound by:

sitting the casualty up and leaning them towards the injured side


28

ADVANCED FIRST AID


applying a sterile dressing to the wound with a layer of plastic over

the top, taped on three sides (leaving the lower side unattached ) arranging immediate transport to hospital

Abdominal Wound By the end of this section, a learner should:

be able to treat an abdominal wound by:

lying the casualty down

loosening any tight clothing such as a belt or shirt

covering the wound with a sterile dressing and holding it firmly

gently raising and supporting the casualtys knees to ease the strain on the injury

transporting to hospital as quickly as possible

understand that they should not touch any protruding intestine

be able to cover any protruding intestine with a clean plastic bag or cling film

Eye Wound By the end of this section, a learner should:

understand that all eye injuries are potentially serious because of the risk to

the casualtys vision understand that you should not try and remove anything sticking to or

embedded in the eyeball

Overseas

Emphasise using gloves

Making local bandages will be covered in your induction and information is also included in section 7.2: First Aid Equipment

It is custom in Africa to wash the wound...if it is a minor graze or small cut, perfect!

However, if it is a large cut or wound there is no need for it to be placed under the water as the blood would carry out any residues from inside the wound. The priority is to stop the bleed - PRESSURE

Elevation is not taught in FAA overseas courses - an international review found that

there is no evidence that pressure in conjunction with elevation is more effective than pressure alone and this is easier to teach

Use of a tourniquet should be taught as treatment for a catastrophic bleed of a limb

that pressure has failed to control evidence from military and remote area studies suggest that these are generally safe, that most side effects are reversible and that severe side effects are rare. Whereas in the UK an ambulance crew will be on scene within minutes, in our project countries, first aiders must deal with everything and it is important to offer them an alternative treatment for such life threatening injuries

Use of an improvised tourniquet will be covered in your induction and in the

resources for this section When applying a tourniquet, make sure that you note the time of application and pass

it on to the hospital When applying a tourniquet, warn the casualty that there limb may be damaged and

that they may lose their limb - in areas where a hospital is nearby this risk is relatively low but much higher when transport times increase - after 6 hours almost all of the limb will have died


29

ADVANCED FIRST AID


Raising the patients legs as part of the treatment for shock is not taught in FAA overseas courses no studies have shown that there is any survival benefit over lying the casualty down alone and at least one study has shown that it worsens outcome. In addition, it is easier to teach that the treatment for shock is to lie the patient down and keep them warm

Improvised bandages should be as clean as possible, non-fluffy, able to produce

sufficient pressure and cover the entire wound. An example would be a clean t-shirt. The bandage should be replaced with a sterile dressing as soon as possible.

In the UK, we ring 999 and wait for an ambulance to arrive for a casualty with a

severe bleed/showing signs of shock/open chest wound etc - in Africa the first aider must arrange for transport to the nearest hospital as quickly as possible - see section 7.10: Moving, Handling & Transporting Casualties

All animal and human bites should be seen by a doctor because of the increased risk

of infection in Africa. Casualties should see a doctor as soon as possible and should be transported to hospital immediately if rabies (see first aid manual) is suspected

Venomous snakes are more common in Africa. A bite from a venomous snake

generally looks like the diagram below but any snake bite should be treated as if the snake is venomous

Casualties with snake bites

should be transported to hospital as quickly as possible with as little

movement as possible to slow movement of venom around the body should be transported laying down with their head and shoulders

raised should be carried and should not be allowed to walk

Do not cut open the wound from a snake bite or try and suck out the venom - this

puts the first aider in danger

Large fangs which inject venom Other teeth


Wear GLOVES

The priority when treating severe wounds is to stop the bleeding

Treatment for a severe bleed is PRESSURE

A tourniquet can be used ONLY when pressure has failed to control a major bleed

from a limb When applying a tourniquet you MUST record the time of application and pass it on

to the hospital When applying a tourniquet you must tell the casualty that they may suffer damage

to, and may lose, their limb - the risk of damage increases the longer it takes to get to hospital - remember, in the case of a catastrophic bleed, its still saving their life

Bleeding, both internal and external can lead to shock

Shock is very dangerous and can cause death

Someone who is in shock will be pale, cold, clammy, feeling weak/tired/dizzy/

nauseous, will have a decreasing level of consciousness and will have a rapid but weak pulse


30

ADVANCED FIRST AID


Treatment for shock is laying the casualty down, keeping them warm and stopping

the bleeding with pressure - transport to HOSPITAL The priority when treating minor wounds is to prevent infection

Treatment for a minor wound is washing the wound and covering it, ideally with

something sterile Infected wounds can lead to severe illness

Any wound that gets badly infected or if the casualty is generally unwell needs to

seen by a doctor/nurse Other infected wounds need to be cleaned and covered

Animal and human bites carry an increased risk of infection because of the bacteria

in the mouth Severe bites should be treated as for a severe wound because the priority is stopping

the bleeding Minor bites should be cleaned with soap and water and covered with a sterile

dressing All bites should be seen by a doctor/nurse because of the increased risk of infection

If someone has been bitten by a snake, make sure the area is safe before treating

Treatment for a snake bite aims to slow the spread of poison spreading around the

body The key parts of treating for a snake bite are: get the casualty to lay still with their

head and shoulders raised, apply a compression bandage to the affected limb and transport to hospital with as little movement as possible (the casualty shouldnt walk)

Do not cut open the wound from a snake bite or try and suck out the venom - this

puts the first aider in danger A casualty with an open chest wound should be sat up and leaned towards the

injured side, a sterile pad and plastic should be applied to the wound and taped on 3 sides. Transport arranged to hospital - initially they should be transported sitting up and leaning to the injured side and as normal if they become unconscious but rolled onto the injured side

A casualty with an abdominal wound should be laid down, a sterile dressing firmly

applied to wound and held firmly in place, the knees raised and supported and then transported to hospital. Any protruding bits of intestine should not be touched but should be covered with a clean, wet dressing. Transport immediately to hospital

A casualty with an eye wound should be told to keep both eyes still. A sterile pad

Resources Page 12 - Severe Bleeding

Page 13 - Tourniquet


31

Learning Objectives Burns By the end of this section, a learner should:

understand that a burn is damage to the skin

understand the different things that can cause a burn such as:

hot objects

hot liquids

radiation

chemicals

cold objects

electricity (2 burns - the entry and exit point)

understand that burns can be different depths:

superficial

partial

full thickness

be able to recognise a burn and identify its depth

understand why burns progressively get worse unless treated

understand why a burn is serious, mainly

that they can lead to infection because the skin is compromised

that they can lead to shock because fluid collects around the burn

that they swell and can compromise the blood supply to different

areas of the body understand that blisters are part of the body's defence against burns and that

you should not burst them understand that electrical burns can cause problems with your heart or brain

understand that chemicals may still be burning, even if you cant see them understand that burns to the airway are very dangerous as they can stop you

being able to breath Treatment Misunderstandings By the end of this section, a learner should:

know some of the misunderstandings local people have about treatment and

the reasons behind them Cooling By the end of this section, a learner should:

understand that unless a burn is cooled and/or the chemical is fully washed

off, damage will continue to be done to the skin understand that a normal burn has to be cooled until it no longer feels like it is

burning and for a minimum of 10 minutes understand that a chemical burn has to be cooled until it no longer feels like it

is burning and for a minimum of 20 minutes

ADVANCED FIRST AID

7.5 BURNS

First Aid Manual


8th Edition - Chapter 9, p189 - 200; Chapter 13, p277


32

understand why clean, cold, running water is the best thing to cool a burn

be able to cool a burn using

running, cold, clean liquids (not strong alcohol)

a basin of cold, clean liquid and a cup

running, unclean, cold liquid and something to cover the burn

a basin of cold, unclean liquid, a cup and something to cover the burn

Covering By the end of this section, a learner should:

understand that covering a cooled burn reduces the risk of infection

understand that a cooled burn should be covered loosely, from end to end,

with a clean, non-fluffy dressing be able to cover a cooled burn using

a plastic bag, washed in clean water

a triangular bandage

a non-adherent dressing and a loose bandage

appropriate improvised equipment

Additional Treatment By the end of this section, a learner should:

understand that anything tight around a limb near a burn such as clothing or

rings should be removed because of the risk of swelling understand why you should not remove anything that is stuck to the burn

Further Treatment By the end of this section, a learner should:

understand which burns should go to hospital as quickly as possible,

specifically burns to the airway

all full thickness burns

large burns - superficial more than 5%, partial more than 1%

burns to the hands

burns to the feet

burns to the genitals

burns that go all the way around an arm or leg

electrical burns

chemical burns

if there is something stuck to the burn

if you are unsure if it is any of the above

burns to children especially babies or the elderly

understand how to look after a burn that doesn't need to go to hospital, mainly

keep it covered until it is dry and at least for a day

keep it clean which may mean keeping it covered for longer with a

non-adherent dressing until a scab has formed or the skin has healed

ADVANCED FIRST AID

7.5 BURNS


33

ADVANCED FIRST AID

7.5 BURNS

Overseas

The English word burn is not very commonly used in Africa. If you try explaining to someone in English what a burn is it can be quite hard so its a good idea to have pictures of burns, or examples of things that can give you a burn, to help you

Burns are generally very badly treated by lay people in Africa because of the wide

variety of local remedies used, such as putting rabbit hair on the burn to help it heal. Invariably, these increase the chance of infection and make the situation worse

In many cases, local remedies are part of the traditions of local culture - do not

rubbish the ideas but explain why they might not work as well as the treatment you are teaching them, in terms of lack of cooling and increased chance of infection - many local people will have stories of burns that have got worse after local treatment and these can help convince people

Burns ALWAYS need to be cooled first - if the burn is not cooled, it will continue to

cause damage deeper and deeper in to the skin even if you cannot see it doing so. Some local remedies are actually quite good BUT only if applied AFTER cooling - for example honey is a natural antiseptic and seals the skin preventing infection from entering. However, if you put honey on a burn which isnt cool, its like adding a glaze to a cooking steak!

The best thing to cool a burn is clean, cold, running water

clean to reduce the chance of infection

cold because you want to cool the burn

running because running water takes heat with it as it goes and stays

cool where as standing water heats up if you put a burn into it You are almost guaranteed to be asked these questions:

What if I dont have water? What if I dont have clean water? What if I dont have much water? What if I dont have running water? combinations of the above!

The priority initially is always to cool the burn If you do not have water, any cool clean liquid will do (except drinks with a high alcohol content such as Konyagi as it really hurts - beer is probably ok) If you only have unclean liquid, cover the burn very loosely with something clean and non-adherent/fluffy - preferably plastic - and pour water over the top. The cooling process will take longer If you don't have very much liquid or liquid is not running, place a big bowl underneath the area you are cooling to collect the liquid and then use a cup or a small bowl to scoop up the liquid and pour it back over the burn

Burns need to be covered completely to prevent infection:

if the burn is being seen at hospital, ideally it should be covered with something plastic and sterile but if you dont have that, it can be covered with anything that is clean and non-fluffy/adherent

if the burn is not severe and does not require hospital - it should still be covered with something clean and non-fluffy and the dressing should be changed regularly (approx every 24 hours) until the skin has healed or a scab has formed

Anything that you put on a burn should be loose because of the risk of swelling -


34

ADVANCED FIRST AID

7.5 BURNS


caused the burn Wear GLOVES

Burns damage the bodys defence, the skin, so there is a big risk of infection Treatment of a burn is cooling to stop more damage and covering to prevent infection

A burn should ALWAYS be cooled before being covered

Cold, clean, running water is the best thing to cool a burn - if you dont have it, do the best you can!

Most burns should be cooled until they no longer feel hot to the casualty - at least 10

minutes for most burns and at least 20 minutes for chemical burns Cooled burns should be LOOSELY covered with something, CLEAN and NON-

FLUFFY/ADHERENT All severe and large burns should be sent to hospital as well as those to delicate

areas and children Chemical burns can continue to burn even if you cant see it or feel it so should be

sent to hospital Electricity can cause problems with your heart or brain and so electrical burns should

be sent to hospital (remember there will probably be 2 burns) Bad burns can lead to shock

Any infected burns should be seen by a doctor as quickly as possible

Minor burns which do not require hospital should still be covered with something

clean and non-fluffy and the dressing should be changed regularly (approx every 24

Resources Page 19 - Burn Depth

Page 20 - Burns (treatment)


35

Learning Objectives Fractures By the end of this section, a learner should:

understand what a fracture is

understand that there are different types of fracture:

open or closed

stable or unstable

be able to recognise a fracture

understand that if you are not completely sure that something is NOT

fractured, you should treat it as if it was fractured until it has been seen by a doctor

Support and Protect By the end of this section, a learner should:

understand that the casualty will automatically adopt a position to support and

protect the fracture understand that the aim of treating a suspected fracture is to support and

protect the fracture site understand the importance of checking for circulation beyond a bandage

be able to check for circulation beyond a bandage

Open Fracture By the end of this section, a learner should:

understand the importance of controlling the bleeding before treating the

fracture be able to control the bleeding of an open fracture by treating the protruding

bone as an embedded object understand that after you have controlled the bleeding, you should treat the

ADVANCED FIRST AID

7.6 FRACTURES

First Aid Manual

9th Edition - Chapter 7, p130 - 158; Chapter 13, p268, p272

8th Edition - Chapter 7, p145 - 174, Chapter 13, p273, p276

The 9th edition no longer includes the use of traction. A fractured leg at an angle may require a small amount of pulling in the line of the limb but this should only be enough to bring the limb carefully into line - the person straightening the leg from the ankle, must continue to hold the leg until all of the bandages are tied.

A recent update to the 9th edition recommends that the arm sling be used for injuries to the collar bone, upper arm and shoulder: The arm should be placed in a comfortable position and immobilised with an arm

sling The hand should be slightly raised above the level of the elbow

In the case of the suspected fractured collar bone care should be taken to make sure

the knot is clear of the site of the injury


36

fracture as normal Upper Limb By the end of this section, a learner should:

be able to use a triangular bandage to apply an elevation sling with padding to

support and protect suspected fractured fingers or a hand injury be able to select and use an appropriate improvised object, to apply an

elevation sling with padding, to support and protect suspected fractured fingers or a hand injury

be able to use a triangular bandage to apply an arm sling with padding to

support and protect a suspected fractured upper arm

a suspected fractured lower arm

a suspected fractured collar bone or injured shoulder

a suspected fractured wrist

be able to select and use an appropriate improvised object to apply an arm

sling with padding, to support and protect a suspected fractured upper arm

a suspected fractured lower arm

a suspected fractured collar bone or injured shoulder

a suspected fractured wrist

be able to apply a broad fold triangular before safe transport to hospital

Transport of casualties with suspected fractures will be covered in section 7.10: Moving, Handling & Transporting Casualties

Upper and Lower Leg By the end of this section, a learner should:

understand when to use the different techniques for immobilising suspected

lower limb fractures based on availability of splints and the transport available be able to immobilise a suspected fracture to the lower or the upper leg

against the uninjured leg using padding and 4 triangular bandages be able to immobilise a suspected fracture to the lower or the upper leg

against the uninjured leg using padding, a splint and 7 triangular bandages be able to immobilise a suspected fracture to the lower or the upper leg

against the uninjured leg using padding, two splints and 7 triangular bandages

Ankle By the end of this section, a learner should:

be able to place padding around a suspected fractured ankle and carefully

keep it in place to support it Pelvis By the end of this section, a learner should:

pelvic fractures can cause a large amount of internal bleeding leading to shock

be able to provide support to a suspected fractured pelvis by immobilising the

legs using padding, 2 triangular bandages (ankles and knees) and placing padding carefully under the knees

Improvisation By the end of this section, a learner should:

be able to immobilise a suspected fractured leg/ankle/pelvis against the

uninjured leg using padding and improvised bandages

ADVANCED FIRST AID

7.6 FRACTURES


37

Transport of casualties with suspected fractures will be covered in section 7.10: Moving, Handling & Transporting Casualties

Skull Fracture By the end of this section, a learner should:

understand that skull fracture may be accompanied by a spinal injury

understand the risk of infection associated with a skull fracture

understand the importance of covering a skull fracture with something as clean

as possible be able to cover a suspected skull fracture with a non-adherent pad or

appropriate improvised dressing understand the importance of transporting a casualty with a suspected skull

fracture to the hospital quickly Transport of casualties with suspected fractures will be covered in section 7.10:

Moving, Handling & Transporting Casualties Facial Fracture By the end of this section, a learner should:

understand the importance of not tying a bandage around the jaw

be able to treat a fractured jaw

be able to treat a fractured cheek bone

understand the importance of transporting a person with a facial fracture to

hospital quickly Transport of casualties with suspected fractures will be covered in section 7.10:

Moving, Handling & Transporting Casualties

Spinal Injury By the end of this section, a learner should:

understand that airway still takes priority

understand the importance of transporting a casualty with a possible spinal

injury to the hospital with as little movement as possible Transport of casualties with suspected fractures will be covered in section 7.10:

Moving, Handling & Transporting Casualties Closed Rib Fracture By the end of this section, a learner should:

be able to protect and support a closed rib fracture using 2 triangular

bandages to apply an arm sling and broad fold understand the importance of transporting a casualty with a broken rib to

hospital

ADVANCED FIRST AID

7.6 FRACTURES

Overseas

In the UK, we ring 999 and wait for an ambulance to arrive for a casualty with a leg

fracture, open rib fracture or spinal injury - in Africa the first aider must arrange for transport to the nearest hospital - see section 7.10: Moving, Handling & Transporting Casualties


38


caused the fracture Wear GLOVES

Types of fracture:

Closed skin is not broken

bone ends may still have damaged nearby blood vessels and so risk

of internal bleeding Open

bone poking through skin

likely to be bleeding

risk of infection

treating the bleed takes priority - treat as an embedded object

Both can be serious and lead to shock Fracture recognition:

Pain Deformity Shortening/bowing Swelling Loss of use Tender Bruising Grating

Always fully expose a fracture site to make sure there is no bleeding

The principle behind treating all suspected fractures is to support and protect the

To make transporting casualties easier, FAA overseas courses teach a number of

different methods for immobilising a fracture to the upper or lower leg: Ideally, the transport will be available that the casualty can lie down flat in,

a splint will be available and there will be enough first aiders to lift the casualty - in this case the fracture should be treated as described in the first aid manual for a leg fracture with removal by first aider

Where the transport will only allow for the casualty to be sitting up with their legs extended but there are enough first aiders to lift the casualty, or there is no splint available, standard immobilisation should be carried out

Where there is not enough first aiders to lift the casualty or there is a potentially dangerous situation where the casualty may need to help move them self quickly - 2 splints should be used to immobilise the injured leg

The use of two splints will be covered in your induction and is included in the

resources for this section To make transporting casualties easier, FAA overseas courses do not teach to treat a

suspected fractured ankle by tying it to the other leg - most ankle fractures can be adequately supported by placing a large amount of padding around the injury, carefully keeping the padding in place with a loose bandage or tape - the casualty can then be assisted into a vehicle for transport to hospital

The specialist equipment required to transport a spinal injury and the subsequent

hospital treatment are unlikely to be available in Africa, therefore we are teaching that

ADVANCED FIRST AID

7.6 FRACTURES


39

fracture before sending to hospital Check for circulation after tying any bandage - if too tight, carefully undo then re-tie

Upper Body Fractures An elevation sling should be used to treat suspected fractured/crushed fingers or a

hand injury and broken ribs that have penetrated the chest An arm sling should be used to treat a suspected fractured collar bone, injured

shoulder, fractured upper arm, fractured lower arm, fractured wrist and closed rib fracture

A broad fold should be used to provide more support before transporting to hospital

Upper and Lower Leg Fractures If the injured leg is bent, carefully bring the leg into line with one person supporting

above and below the fracture site, whilst another holds at the ankle - the person at the ankle should not let go until the leg is fully immobilised

The injured leg should be immobilised (stopped moving) with padding

Where the casualty can lay down in the transport available and there is a splint:

place a splint with padding around it alongside the injured leg which is long enough to extend from the foot to the patients armpit

place padding between the legs (especially at the fracture site and between the joints)

tie the injured leg to the uninjured leg and the splint using bandages tied in the following order: 1. Ankles - narrow fold - figure of 8 2. Chest - broad fold 3. Hips - broad fold 4. Knees - broad fold 5. Above the fracture site - broad fold 6. Below the fracture site - broad fold 7. Floater - broad fold

Where the casualty can only sit up, not lay down, in the transport available:

place padding between the legs (especially at the fracture site and between the joints)

tie the injured leg to the uninjured leg using bandages tied in the following order:

1. Ankles - narrow fold - figure of 8 2. Knees - broad fold 3. Above the fracture site - broad fold 4. Below the fracture site - broad fold

Where there is not enough first aiders to lift the casualty or there is a potentially

dangerous situation where the casualty may need to help move them self quickly: place a splint with padding around it alongside the injured leg which is long

enough to extend from the foot to the patients armpit place a splint with padding around it between the casualties legs which is

long enough to extend from the top of their thigh to their feet tie the injured leg to both splints using bandages tied in the following order:

1. Ankles - narrow fold 2. Chest - broad fold 3. Hips - broad fold 4. Knees - broad fold 5. Above the fracture site - broad fold 6. Below the fracture site - broad fold

ADVANCED FIRST AID

7.6 FRACTURES


40

7. Floater - broad fold The casualty should be transported to hospital

Ankle Fracture The injured leg should be supported by tying it to the other leg with three triangular

bandages with padding in between the legs (especially at the fracture site and between joints)

The bandages should be tied in the following order:

1. Above the ankle - broad fold 2. Knees - broad fold 3. Around the feet - narrow fold

The casualty should be transported to hospital

Pelvic Fracture Pelvic fractures can cause a large amount of internal bleeding leading to shock

The pelvis should be supported by immobilising the pelvis with two triangular

bandages - ankles (narrow fold) and knees (broad fold) - with padding in between the legs

When the legs are immobilised, carefully raise the knees and slide padding

underneath - this relieves pressure on the bladder The casualty should be transported to hospital

Skull Fracture Remember that anything which caused a skull fracture may have caused damage to

the spine A skull fracture compromises the bodys defence against bacteria reaching the brain You should cover a skull fracture with something as clean as possible as quickly as

possible to reduce the chances of bacteria reaching the brain There are many complications associated with skull fracture so a casualty should be

transported to hospital as quickly as possible Facial Fractures Any fracture of the bones in the face can compromise the casualties airway,

especially if they vomit, and so need to be transported to hospital quickly Always make sure the airway is clear - ask the casualty to spit out any blood or

displaced teeth Gently apply a cold compress to reduce swelling

Tying a bandage under the jaw and over the top of the head secures the mouth shut

and will further compromise the airway, especially if the casualty becomes unconscious or vomits so it should not be done!

If the lower jaw is injured, make sure the jaw is carefully supported by getting a

casualty to hold a soft pad against it Spinal Injury Airway still takes priority - if the casualty is unconscious, roll them into the recovery

position Move the casualty as carefully as possible - see section 7.10: Moving, Handling &

Transporting Casualties Closed Rib Fracture Treatment for an open fractured rib is covered in section 7.4: Blood Loss & Shock

ADVANCED FIRST AID

7.6 FRACTURES


41

Resources Page 21 - Arm Sling

Page 22 - Elevation Sling

A rib fracture should be treated using an arm sling and broad-fold applied to the

injured side

ADVANCED FIRST AID

7.6 FRACTURES


42

ADVANCED FIRST AID

7.7 HEAD INJURY

First Aid Manual


8th Edition - Chapter 8, p179 -182

Learning Objectives Head Injury By the end of this section, a learner should:

be able to recognise the differences between concussion and compression

understand that a head injury may also suggest an injury to the neck

Concussion By the end of this section, a learner should:

understand how concussion causes a brief disturbance of normal brain activity

be able to recognise the signs of concussion including

brief period of impaired consciousness following a blow to the

head dizziness or nausea

loss of memory of events leading up to or during the event

causing the injury mild, generalised headache, confusion

be able to treat a casualty by

sitting them down

closely monitoring them whilst consciousness is impaired

ensure a 'responsible adult' continues monitoring once casualty appears to

recover be able to give advice on what to look out for suggesting that the head injury is

more serious Compression By the end of this section, a learner should:

understand that compression is a serious injury that requires urgent medical

attention be able to recognise the signs of compression including:

deteriorating level of response AVPU history of recent head injury

intense headache

noisy, slow breathing

slow, yet full and strong pulse

unequal pupil size

weakness and/or paralysis down one side of the face or body

drowsiness

change in personality or behaviour

understand that signs and symptoms of compression may appear a relatively

long time after the initial injury be able to treat a casualty by

sitting them down

closely monitoring them whilst consciousness is impaired


43

ADVANCED FIRST AID

7.7 HEAD INJURY

transporting them to hospital as quickly as possible - sitting whilst

still conscious and then as usual if they become unconscious Skull fracture By the end of this section, a learner should:

understand a serious blow to head can result in a fracture to the skull

understand a blow of that force could cause an injury to the neck

understand displaced bone may cause a compression injury to the brain

be able to recognise a skull fracture by:

wound or bruise on head

soft area or depression on the scalp

bruising or swelling behind one ear

bruising around one or both eyes

clear fluid or watery blood coming from the nose or an ear

blood in the white of the eye

distortion or lack of symmetry to the head or face

signs of a compression injury

understand that a skull fracture may compromise the brains defences against infection

be able to carefully apply a sterile pad - using the first aiders hand - to the affected area to limit the risk of infection

understand this is a serious injury and the casualty needs to be transported as

soon as possible

Overseas The casualty should be taken to hospital as quickly as possible - transport should be

arranged

Key Points An injury to the head may alert you to an underlying brain injury

Monitoring is key

Improvement of symptoms suggests concussion, deterioration suggests compression

Compression requires transport to hospital as quickly as possible

Confusion/agitation, nausea/vomiting, severe headache in the hours/days following a

head injury requires transport to hospital Clear fluid or watery blood leaking from the ears or nose, as well as bruising around

the eyes or ears is a sign of serious injury. Casualty should be transported as soon as possible to hospital

A blow to the head may also cause neck injury - be prepared to treat patient as a


44

Learning Objectives Dehydration, Diarrhoea and Vomiting By the end of this section, a learner should:

understand the complications of dehydration, diarrhoea and vomiting, mainly

that it can lead to shock

that you lose salts and sugars which are necessary to live

both of the above can lead to death

be recognise dehydration, diarrhoea and vomiting

be able to treat mild dehydration, diarrhoea and/or vomiting by encouraging

the casualty to drink plenty of fluids be able to treat severe dehydration, diarrhoea and vomiting using a

rehydration solution, ideally a ready made solution, otherwise a mixture of: 1 litre of water

5 teaspoons of sugar

1 teaspoon of salt

understand that severe or persistent dehydration, diarrhoea and/or vomiting

requires hospital treatment

ADVANCED FIRST AID

7.8 MEDICAL CONDITIONS - DEHYDRATION, DIARRHOEA & VOMITING

First Aid Manual

9th Edition - Chapter 9, p190; Chapter 11, p227

8th Edition - Chapter 12, p247

For changes between the manuals, see Learning Objectives and Africa.

Overseas The latest edition of the first aid manual recommends the use of rehydration solution

for the treatment of severe dehydration. Unfortunately, this is difficult to obtain or expensive in Africa. The recipe above provides an alternative.

Always remember that severe dehydration whether as the result of diarrhoea and

vomiting or not, requires urgent medical attention as oral fluids may not be enough to treat the person effectively

Key Points Dehydration can be a severe, life threatening condition

A person who is dehydrated requires salts and sugars as well as water

Severe dehydration requires medical attention

If the vomiting or diarrhoea is severe or persistent ,medical attention is required

If there is any blood or mucus present in either the stools or vomit, medical attention

is required


45

Learning Objectives Asthma By the end of this section, a learner should:

understand that asthma is a medical condition that causes periods of

breathing difficulty due to narrowing of the airways be able to recognise the signs of an attack including:

wheezing when breathing out

difficulty speaking leading to short sentences and whispering

coughing

distress and anxiety

features of hypoxia such as grey/blue tinge to the lips, earlobes

and nail beds exhaustion in a severe attack

if attack worsens casualty may lose consciousness and stop

breathing be able to treat someone with an asthma attack by:

sitting casualty down in position most comfortable for them, likely

to be upright assisting them to take their inhaler if available

encouraging slow deep breathing

if difficulty continues encourage them to take another dose

ADVANCED FIRST AID

7.8 MEDICAL CONDITIONS - ASTHMA

First Aid Manual



Key Points Asthma is a medical condition that causes difficulty breathing

Keep casualty calm

Assist them to take their inhaler if available

If they are not improving, transport to hospital as quickly as possible

Overseas If the casualty is not improving, they should be transported to hospital - this should be

in a sitting position unless they become unconscious


46

Learning Objectives

Anaphylaxis By the end of this section, a learner should:

understand what anaphylaxis is and why it is considered a medical emergency

be able to recognise signs of an anaphylactic reaction including

features if an allergy such as red itchy rash, itchy and watery

eyes and abdominal pain, vomiting and diarrhoea

difficulty breathing, with the casualty wheezing and gasping for

air pale or flushed skin

visible swelling of tongue and throat with puffiness around eyes

feeling of terror

confusion and agitation

signs of shock leading to collapse and loss of consciousness

be able to treat a casualty experiencing anaphylactic shock by

arranging transport to hospital as quickly as possible

assisting the patient to take any medication (adrenaline) they

may have to relieve symptoms (from an auto-injector for example)

helping the casualty to sit in an upright position that best relieves

their breathing difficulty monitoring and recording vital signs, repeating doses of

adrenaline (epinephrine) at 5 minute intervals

ADVANCED FIRST AID

7.8 MEDICAL CONDITIONS - AN

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